Coronary Stent Procedure: A Step-by-Step Guide

Understanding the Arterial Approach

During a coronary stent procedure, doctors typically use an arterial pathway to access the heart. While the femoral artery in the groin was commonly used in the past, most patients today opt for the radial artery in the wrist. This method involves inserting a catheter through the radial artery, followed by the placement of a guidewire. The catheter, also known as a guiding catheter, travels through the brachial artery and then into the subclavian artery before reaching the ascending aorta and finally the aortic root.

Guiding the Catheter to the Coronary Arteries

Once the guiding catheter reaches the aortic root—also known as the aortic sinus—it is positioned near the openings of the left and right coronary arteries. The catheter is carefully maneuvered to engage either the left or right coronary artery, where an angiogram is performed to locate any blockages. A guidewire is then advanced through the catheter to navigate through the coronary arteries and reach the site of the narrowing.

Using Balloon Angioplasty to Open the Artery

After the guidewire crosses the narrowed segment of the coronary artery, a balloon catheter is passed over the wire to the site of the blockage. When the balloon is inflated with contrast dye, it expands the narrowed artery. This process, known as Percutaneous Transluminal Coronary Angioplasty (PTCA), helps break up plaque buildup, stretch the artery walls, and sometimes causes minor tears in the inner lining of the artery to restore blood flow.

Implanting the Stent

Why Stents Are Used

While balloon angioplasty can successfully open up a blocked artery, some patients may experience re-narrowing over time. To prevent this, a stent—a small, mesh-like tube—is often implanted. The stent is mounted on a balloon catheter and guided over the existing wire to the treatment site.

The Stent Deployment Process

Once in position, the balloon is inflated again, which expands the stent and presses it against the artery wall. After the balloon is deflated and removed, the stent remains in place, providing long-term support to keep the artery open. This stage of the procedure is known as stent deployment or stent implantation.